Occipital Blocks

Anatomy

Anatomy

The greater occipital nerve is a branch of the dorsal primary ramus of the C2 spinal nerve.  It ascends from between the first and second cervical vertebrae along with the lesser occipital nerve.  It travels deep into the cervical paraspinous musculature and innervates the skin along the posterior part of the scalp to the vertex, as well as to the scalp at the top of the head, over the ear and also over the parotid glands.  People with greater occipital headaches feel pain starting at the base of their skull (on one side or it can be on both sides) that travels up the back of their skull to the top of their skull and into the forehead (mimicking a “Mohawk”).

Procedure

Procedure

The block is an injection of an anesthetic (lidocaine) and a steroid (kenalog) next to the greater occipital nerve.  The injection reproduces the headache caused by greater occipital neuritis, and then rapidly relieves it.  The length of relief can be hours, days, or longer.  Sometimes the blocks need to be repeated.  Icing and doing a massage of the area with ice is also recommended,  These blocks are very safe and have very few risks involved.  These risks include pain at the point of the needle insertion, bleeding (which is common but is stopped easily and is only temporary),  infection, and reactions to the medications used.